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Epilepsy is a brain disorder characterized by recurrent and unpredictable interruptions of normal brain function, called epileptic seizures (Fisher et al., 2005). Epilepsy occurs in 1-2% of children (Hauser & Kurland, 1975). Twenty-five percent of children with epilepsy continue to seize despite appropriate medical management and are diagnosed as medically refractory epilepsy (Hauser, 1993). Medically refractory epilepsy is defined as seizures that continue despite at least two appropriate first line anti-epileptic medications at maximally tolerated serum levels for 2 years (Snead, 2001). A subset of patients with medically refractory epilepsy can be surgically treated after anti-epileptic medications fail. Successful control of the seizures can be achieved in children with intractable partial epilepsy by surgical resection of the epileptogenic foci (Duchowny 1995; Wyllie 1998; Snead 2001). In our institution, magnetoencephalography (MEG) is an essential part of the diagnostic workup in all patients undergoing presurgical evaluation. We introduced the concept of MEG-guided epilepsy surgery (Minassian et el., 1999; Otsubo et al., 1999, 2001a, 2001b; Holowka et al., 2004; Iida et al., 2005; RamachandranNair et al., 2007; Mohamed et al., 2007; Ochi et al., 2008). In patients with intractable partial epilepsy, MEG is a powerful tool for presurgical evaluation to predict an epileptogenic zone (Wheless et al., 1999; Pataraia et al., 2004; Paulini et al., 2007). The epileptogenic zone is a region of cortex that can generate epileptic seizures (Rosenow & Luders, 2001). By definition, total removal or disconnection of the epileptogenic zone is necessary and sufficient for seizure freedom. In this chapter, we would like to demonstrate our presurgical evaluation, including scalp videoelectroencephalography (EEG) monitoring to capture seizures and interictal epileptiform discharges, and clinical MEG studies and analyses to estimate the epileptogenic zone.

Clinical MEG Analyses for Children with Intractable Epilepsy